Increases in Advance Directive Completion Through the Patient Portal Among Younger and Healthier Population During the COVID-19 Pandemic

Abstract

Objectives:

To identify differences in the number and characteristics of patients who completed a Medical Durable Power of Attorney (MDPOA) form through the patient portal during the COVID-19 pandemic compared to pre-pandemic.

Methods:

Data, including portal-based MDPOA forms, were extracted from the electronic health record at one U.S. institution (July 2017–May 2023). The pandemic period was defined as March 26, 2020, or after.

Results:

397,682 patients added an MDPOA form during the study period. There was an increase in the proportion of portal-based MDPOA forms from 4.6% pre-pandemic to 5.1% during the pandemic (p < 0.001). Patients who used the portal to complete the MDPOA form during the pandemic were younger (p < 0.001) and had fewer comorbidities (p < 0.001) compared to pre-pandemic patients who completed a portal-based MDPOA form.

Conclusion:

MDPOA completion is important for patients of all ages and health statuses. Having MDPOA tools within a patient portal can support uptake among younger, healthier populations.

Keywords

advance care planning COVID-19 medical decision-making patient portal surrogate decision maker

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References

Curtis

, Kross

, Stapleton

. The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel Coronavirus 2019 (COVID-19). JAMA, 2020; 323(18):1771–1772; doi: 10.1001/jama.2020.4894

Pattison

. End-of-life decisions and care in the midst of a global coronavirus (COVID-19) pandemic. Intensive Crit Care Nurs, 2020; 58:102862; doi: 10.1016/j.iccn.2020.102862

Shaver

. The State of Telehealth before and after the COVID-19 pandemic. Prim Care, 2022; 49(4):517–530; doi: 10.1016/j.pop.2022.04.002

Strawley

, Richwine

. Individuals’ access and use of patient portals and Smartphone Health Apps, 2022. Office of the National Coordinator for Health Information Technology. Data Brief, 2023; 69.

Sudore

, Lum

, You

, et al. Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage, 2017; 53(5):821–832.e1; doi: 10.1016/j.jpainsymman.2016.12.331

Rao

, Anderson

, Lin

, et al. Completion of advance directives among U.S. consumers. Am J Prev Med, 2014; 46(1):65–70; doi: 10.1016/j.amepre.2013.09.008

Lum

, Brungardt

, Jordan

, et al. Design and implementation of patient portal–based advance care planning tools. J Pain Symptom Manage, 2019; 57(1):112–117.e2; doi: 10.1016/j.jpainsymman.2018.10.500

Jordan

, Brungardt

, Phimphasone-Brady

, et al. Patient perspectives on advance care planning via a patient portal. Am J Hosp Palliat Care, 2019; 36(8):682–687; doi: 10.1177/1049909119832820

Lee

, Perry

, Hoerger

, et al. Advance care planning practice patterns before and during a pandemic. J Palliat Med, 2024; 27(2):246–250; doi: 10.1089/jpm.2023.0117

10.

Centers for Disease Control and Prevention. Underlying conditions and the higher risk for severe COVID-19. Available from: https://www.cdc.gov/covid/hcp/clinical-care/underlying-conditions.html [Last accessed: February 19, 2025].

11.

Charlson

, Pompei

, Ales

, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 1987; 40(5):373–383; doi: 10.1016/0021-9681(87)90171-8

12.

Bernal

, Cummins

, Gasparrini

. Interrupted time series regression for the evaluation of public health interventions: A tutorial. Int J Epidemiol, 2017; 46(1):348–355; doi: 10.1093/ije/dyw098

13.

Huang

, Khurana

, Mastorakos

, et al. Patient portal messaging for asynchronous virtual care during the COVID-19 pandemic: Retrospective analysis. JMIR Hum Factors, 2022; 9(2):e35187; doi: 10.2196/35187

14.

Portz

, Brungardt

, Shanbhag

, et al. Advance care planning among users of a patient portal during the COVID-19 pandemic: Retrospective observational study. J Med Internet Res, 2020; 22(8):e21385; doi: 10.2196/21385

15.

Stewart

, Hogan

, Nicklas

, et al. The promise of patient portals for individuals living with chronic illness: Qualitative study identifying pathways of patient engagement. J Med Internet Res, 2020; 22(7):e17744; doi: 10.2196/17744

16.

Kruse

, Argueta

, Lopez

, et al. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: A systematic review. J Med Internet Res, 2015; 17(2):e40; doi: 10.2196/jmir.3703

17.

Brungardt

, Daddato

, Parnes

, et al. Use of an ambulatory patient portal for advance care planning engagement. J Am Board Fam Med, 2019; 32(6):925–930; doi: 10.3122/jabfm.2019.06.190016

18.

Nishii

, Campos-Castillo

, Anthony

. Disparities in patient portal access by US adults before and during the COVID-19 pandemic. JAMIA Open, 2022; 5(4):ooac104; doi: 10.1093/jamiaopen/ooac104

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